Is home birth safer than hospital birth?

Monica Beyer is a mom of four and has been writing professionally since 2000, when her first book, Baby Talk, was published. Her main area of interest is attachment parenting and all that goes with it, including breastfeeding, co-sleepin...

Chances of severe complications

Home birth proponents often feel that birthing at home is the safest choice, and now there is a large-scale study to back that line of thought up. We talked with moms who have had both types of births and asked why they chose them, and how this study stacks up to their experiences.

Home birth is on the rise, but some feel that women who choose that route are taking chances they shouldn’t. Yet others feel that hospitals are riskier than birthing at home. Who is right? One study seems to agree with the latter.

Dutch researchers investigated the chances of severe complications in low-risk women and found that home birth is less risky in that country. Does this mean home birth is right for you?

The research

The researchers conducted a large-scale study of approximately 150,000 low-risk women in the Netherlands who gave birth between 2004 and 2006 to see which group — home birth or hospital birth — had the most occurrences of severe complications, such as the need for a large blood transfusion or being admitted to intensive care.

For first-time moms who fall into the low-risk category, the risk of severe complications was nearly the same no matter where the birth happened. The study found that the chance of complications was 2.3 per 1,000 for home births, compared with 3.1 per 1,000 for planned hospital births.

However, for moms who had already given birth before, the home birth crowd was less likely to experience postpartum hemorrhage — 19.6 per 1,000 for a planned home birth, compared with 37.6 per 1,000 for planned hospital births.

The system

The system in the Netherlands, where 20 percent of moms give birth at home, is working well and depends on several different factors, such as good risk selection, backup transport in case of emergencies and well-trained midwives. In the U.S., similar components to successful home birth are also employed, which help alleviate concerns parents-to-be may have about the safety of giving birth at home.

The benefits for those who choose that path are plentiful. “I have felt nurtured and cared for by my midwives, and being in the comfort of my own home adds an element of well-being that i can't really quantify,” shared Rebecca, mother of four. “It's priceless to me to be able to birth at home.”

How do we compare?

The American C-section rate is very high — 32.8 percent according to data from the CDC for 2010 — and many feel that the way birth is managed is a direct contributor to that number. There are a few factors that are frequently blamed for both high C-section rates and maternal complications — inductions when the mother’s cervix (and baby) isn’t ready, the use of epidurals, the lack of support for pain-management techniques and fetal monitoring that confines mom to a bed.

“My first was a hospital birth and I feel like even though there was cause for me to be there (meconium, shoulder dystocia and hemorrhaging), some of it could have been avoided had I not been flat on my back with my knees to my chest,” remembered Heather, mom of two. “My second birth was a planned home birth and there was not a single problem to be found. Extremely textbook! I had great confidence in myself and my midwives. It was quiet, joyous and whole.”

Rebecca’s first birth was at a hospital, where she wound up facing tons of interventions. “I was pressured into Pitocin to ‘augment’ my labor, and then pressured into an epidural so I’d relax and stop tensing due to the pain from the Pitocin-induced contractions,” she told us. “Then, when I was getting close to a 24-hour time limit to deliver (due to risk of hospital-induced infection), I was told I'd need a C-section.” She chose home birth with her second, third and fourth babies and found those experiences to be far superior.

Good midwives are imperative

Of course, not all home births go according to plan, and in case of an emergency, your caregiver needs to know when to transport you to a hospital and what to do in the meantime if things go south. Ashley, from Canada, has had three home births and while the first two were managed well, the third wasn’t. She suffered from hemorrhaging after her daughter was born, but was left standing up and hanging onto a windowsill in her bathtub. She passed out, hit her head and lost her pulse. She was never transferred to the hospital, and while everything is fine now, she and her baby both suffered at the hands of those who were caring for her.

The bottom line

While this study highlights the excellent system in the Netherlands, there is no reason that moms in the U.S. can’t also have a safe home birth as long as they meet the criteria set out by their midwives and have a backup emergency plan in place. This research can also have an effect on your choice as well — if you are low-risk and home birth is safer than hospital birth, then why not go for it?